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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 195850173
Report Date: 09/20/2023
Date Signed: 09/20/2023 06:13:08 PM


Document Has Been Signed on 09/20/2023 06:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364



FACILITY NAME:A'MORECARE HOME ASSISTED LIVINGFACILITY NUMBER:
195850173
ADMINISTRATOR:ANNETTE AMIRKHANIANFACILITY TYPE:
740
ADDRESS:23511 BERDON STREETTELEPHONE:
(818) 704-0012
CITY:WOODLAND HILLSSTATE: CAZIP CODE:
91367
CAPACITY:6CENSUS: 0DATE:
09/20/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Annette Amirkhanian, Administrator over the telephoneTIME COMPLETED:
11:45 AM
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Licensing Program Analyst (LPA) Olson arrived at the facility unannounced to conduct a required annual visit at 11:45 a.m. When LPA arrived, there was no one at the facility. LPA called Administrator who stated no residents were currently in the facility and the facility was undergoing renovations and was unable to come to the facility.

LPA looked in the windows and observed an empty bedroom and minimal furniture in the living/dining room. LPA did not observe any personal belonging indicating anyone lived or resided in the facility. LPA did not observe any staff or persons in the home.



LPA will continue the inspection at a later time/date.

Report issued via email requesting Administrator sign and return.
SUPERVISOR'S NAME: Kelly BurleyTELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Jeannette OlsonTELEPHONE: (805) 635-4718
LICENSING EVALUATOR SIGNATURE:
DATE: 09/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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